<!DOCTYPE html>
<html>
    <head>
        <meta charset="utf-8" />
        <meta name="viewport" content="width=device-width, initial-scale=1" />
        <title>
        </title>
        <link rel="stylesheet" href="css/jquery.mobile-1.1.0.min.css" />
        <link rel="stylesheet" href="css/my.css" />
        <link rel="stylesheet" href="css/jqm-datebox.css" />

        <script src="js/jquery.min.js">
        </script>
        <script src="js/phonegap-1.1.0.js">
        </script>
        <script src="js/jquery.mobile-1.1.0.min.js">
        </script>
        
        <script src="js/jqm-datebox.core.js">
        </script>
        
        
        <script src="js/jquery.mobile.datebox.js">
        </script>
       
        <script src="js/gphone.js">
        </script>
        <script>
            //reset type=date inputs to text
            $( document ).bind( "pageinit", function(){
                
                var id=getParameterByName('id');
                
                var urlwithid='patient_info.html?id='+id;
                $('#back').attr('href',urlwithid);
                $('#patient_id').val(id);
                
               
            });	
                
               
                
        </script>

    <div data-role="page" id="patient_details">

        <div data-theme="b" data-role="header">
            <h3>
                Add Patient Visit
            </h3>
            <a data-role="button" data-iconpos="notext" data-transition="fade" data-icon="back" href="#" rel="external" id="back">
                Back to list
            </a>
        </div>

        <div data-role="content">	
            <div data-role="fieldcontain">
                <label for="complaint">Complaint:</label>
                <textarea cols="40" rows="8" name="complaint" id="complaint"></textarea>

            </div>
            <div data-role="fieldcontain">
                <label for="treatment">Treatment:</label>
                <textarea cols="40" rows="8" name="treatment" id="treatment"></textarea>
            </div>
            <div data-role="fieldcontain">
                <label for="visit_date">Visit Date:</label>
                <input name="visit_date" id="visit_date" type="date" data-role="datebox" data-options='{"mode": "calbox", "useFocus": true}' />
                <input name="patient_id" id="patient_id" type="hidden" value=""/>
            </div>
            <a data-role="button" data-transition="fade" onclick="addVisit()" id="submit" data-icon="plus" >
                Add Visit
            </a>
        </div>
        <div data-theme="b" data-role="footer" data-position="fixed">
            <h3>
                Designed by Geotekh
            </h3>
        </div>
    </div>

</body>
</html>